DOI: http://dx.doi.org/10.18203/2349-2902.isj20194072

Comparative study of wound sequlae in layer closure and retention closure of midline laparotomy

Euvalingam D., Sendhil Nathan

Abstract


Background: Layered closure of the abdomen has been considered to be ideal until recently however single layer mass (retention) closure technique, in which all the layers of the abdominal wall are closed in single layer is being increasingly used by surgeons. We conducted this study to analyze outcome measures in patients in whom wound closure was done by retention closure and layered closure.

Methods: This was a prospective comparative study in which 60 patients undergoing elective or emergency laparotomy were included on the basis of a predefined inclusion and exclusion criteria. In 30 cases (50%) layer closure was done whereas in remaining 30 (50%) patients retention closure technique was used. Major outcome measures studied were time required for wound closure and post-operative complications.

Results: Out of 60 studied cases there were 42 (70%) males and 18 (30%) females with M: F ratio of 1: 0.42.The time required for closure in layered suture group (group A) was 26.76±3.36 whereas in case of retention closure suturing it was 19.36±4.35. The difference was found to be statistically highly significant (p<0.0001). The complications rates were found to be statistically significantly higher in layer suturing (Group A) as compared to retention suture group (Group B).

Conclusions: We conclude that retention suturing is preferable as compared to layered suturing in patients undergoing midline laparotomy in terms of time required for closure of wound and post-operative complication rates.


Keywords


Laparotomy, Midline incision, Layered closure, Retention suturing, Outcome

Full Text:

PDF

References


Devor D, Knauft RD. Exploratory laparotomy for abdominal pain of unknown etiology. Diagnosis, management, and follow-up of 40 cases. Arch Surg. 1968;96(5):836-9.

Mattox KL, Allen MK, Feliciano DV. Laparotomy in the emergency department. JACEP. 1979;8(5):180-3.

Dharap SB, Noronha J, Kumar V. Laparotomy for blunt abdominal trauma-some uncommon indications. J Emerg Trauma Shock. 2016;9(1):32-6.

Gejoe G, Yadev I, Rahul M. Emergency Laparotomies at a Tertiary Care Center-a Hospital-Based Cross-Sectional Study. Indian J Surg. 2017;79(3):206-11.

Brown SR, Goodfellow PB. Transverse verses midline incisions for abdominal surgery. Cochrane Database Syst Rev. 2005;19(4):CD005199.

Proske JM, Zieren J, Muller JM. Transverse versus midline incision for upper abdominal surgery. Surg Today. 2005;35(2):117-21.

Son D, Harijan A. Overview of surgical scar prevention and management. J Korean Med Sci. 2014;29(6):751-7.

Pollock AV, Greenall MJ, Evans M. Single-layer mass closure of major laparotomies by continuous suturing. J R Soc Med. 1979;72(12):889-93.

Dudley HA. Layered and mass closure of the abdominal wall. A theoretical and experimental analysis. Br J Surg. 1970;57(9):664-7.

Rahbari NN, Knebel P, Diener MK, Seidlmayer C, Ridwelski K, Stoltzing H, et al. Current practice of abdominal wall closure in elective surgery - Is there any consensus?. BMC Surg. 2009;9:8.

Ramneesh G, Sheerin S, Surinder S, Bir S. A prospective study of predictors for post laparotomy abdominal wound dehiscence. J Clin Diagn Res. 2014;8(1):80-3.

Simpson G, Parker A, Hopley P, Wilson J, Magee C. Pre-operative psoas major measurement compared to P-POSSUM as a prognostic indicator in over-80s undergoing emergency laparotomy. Eur J Trauma Emerg Surg. 2018. doi: 10.1007/s00068-018-1025-5.

Deshmukh SN, Maske AN. Mass closure versus layered closure of midline laparotomy incisions: a prospective comparative study. Int Surg J. 2018;5:584-7.

Singh-Ranger D, Leung E, Lau-Robinson ML, Ramcharan S, Francombe J. Nontraumatic Emergency Laparotomy: Surgical Principles Similar to Trauma Need to Be Adopted? South Med J. 2017;110(11):688-93.

Koirala R, Mehta N, Varma V, Kapoor S, Kumaran V, Nundy S. Urgent Redo-Laparotomies: Patterns and Outcome-A Single Centre Experience. Indian J Surg. 2015;77(3):195-9.

Chiu WC, Shanmuganathan K, Mirvis SE, Scalea TM. Determining the need for laparotomy in penetrating torso trauma: a prospective study using triple-contrast enhanced abdominopelvic computed tomography. J Trauma. 2001;51(5):860-8.

Singh G, Ahluwalia R. A comparison between mass closure and layered closure of midline abdominal incisions. Med J DY Patil Univ. 2012;5(1):23-6 .

Chalya PL, Massinde AN, Kihunrwa A, Mabula JB. Abdominal fascia closure following elective midline laparotomy: a surgical experience at a tertiary care hospital in Tanzania. BMC Res Notes. 2015;8:281.

Patel SV, Paskar DD, Nelson RL, Vedula SS, Steele SR. Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications. Cochrane Database Syst Rev. 2017;11:CD005661.

Bande A, Saxena D, Nichkaode PB, Akhtar M. A comparative study of single layer closure versus conventional layered closure of laparotomy wounds. Int Surg J. 2018;5:1459-63.